Reconstruction with customized, 3D-printed prosthesis after resection of periacetabular Ewing’s sarcoma in children using "triradiate cartilage-based" surgical strategy:a technical note

Abstract

Background Surgery for Ewing sarcoma involving acetabulum in children is challenging. Considering the intrinsic structure of immature pelvis, trans-acetabular osteotomy through triradiate cartilage might be applied. The study was to describe the surgical technique and function outcomes of trans-acetabular osteotomy through triradiate cartilage and reconstruction with customized, 3D-printed prosthesis. Methods Two children with periacetabular ES were admitted to our hospital. The pre-operative imaging showed the triradiate cartilage was not penetrated or wholly affected by tumor. After neoadjuvant chemotherapy, the tumor was excised by trans-acetabular osteotomy basing on “triradiate cartilage strategy” and the acetabulum was reconstructed with the customized, 3D-printed prosthesis. The prosthesis was designed in Mimics software basing on the images from CT, optimized by topology technique, and examined in FE model. After implantation, the oncological and functional outcomes were evaluated with radiography, CT, and MSTS score. Results The operation time and intra-operative blood loss in these two children were 3.5h, 2.5h and 300 ml, 600 ml, respectively. The postoperative specimen showed the tumor was en bloc removed with safe margin. In the latest follow-up (48 months and 24 months), both patients were free of disease and had satisfactory function according to MSTS score. The radiography indicated the prosthesis fit the defect well without loosening. Conclusion The customized, 3D-printed prosthesis could provide optimal reconstruction of pelvic ring and satisfactory hip function after trans-acetabular osteotomy in children. The translational potential of this article This study provides promising results of implantation of customized 3D printing prosthesis in children’s pelvic sarcoma, which may bring a new design method for orthopaedic implants.

Application of three-dimensional printing technology in peripheral hip diseases

“…Similarly, Wang et al [ 41 ]used a 3D-printed integrated prosthesis to treat acetabular malignancy, which resulted in improved hip function and reduced postoperative pain, respectively, indicating its significant advantages ( Figure 2 ). Zhu has observed great results when using bespoke 3D printed prostheses for hip environment repair in children with periprosthetic Ewing’s sarcoma excision [ 42 ].

Figure 2.

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A Pelvic Reconstruction Procedure for Custom-Made Prosthesis Design of Bone Tumor Surgical Treatments

“…It also allows a precise pre-operative planning of the surgical procedure, this including the positioning of the prosthesis, and the setting of corresponding bone cuts. The potential better long-term clinical and functional results are supported by the good shortterm results [3,5,7,[13][14][15][16][17][18][19][20][21][22][23][24]. 3D printed implants have attracted much attention nowadays also because of faster production and lower costs, together with the accurate optimization and control of the overall geometry, both in terms of the external roughness and internal topology [25].…”

“…In particular, according to the Enneking and Dunham classification [2], type I involves the iliac region, type II the periacetabular region, type III the pubis or ischium, and type IV the lateral part of the sacrum. Most of these reconstructions involve the acetabulum, which implies the replacement of the hip joint [3,4]. For all pelvic resection and reconstruction procedures, the primary goals are the restoration of the physiologic joint motion and the maintenance of good quality of life [4].…”

“…The exact definition of the tumor, together with the skeletal and soft tissue structures, requires complete computer-based anatomical models, to be obtained via multimodal medical image scans using computed tomography (CT) and magnetic resonance imaging (MRI), and accurate 3D reconstructions. These final 3D models, observed separately and also registered superimposed on one another in 3D space, allow visualization, identification and localization of all important anatomical structures, necessary for a careful pre-surgical planning and implant design [3,38,39]. For these procedures, and for the following virtual surgery planning, a close collaboration between surgeons, radiologists, bioengineers, and technicians is necessary.…”

Clinical Effect of Laparoscopic Radical Surgery Combined with Neoadjuvant Chemotherapy in Treating Cervical Cancer and Its Influence on Postoperative Complications and Adverse Reaction Rates

“…Cervical cancer is a common malignant tumor in the female reproductive system characterized by high mortality and recurrence rate, but usually, no specific clinical manifestations occur before the onset of the disease, so patients are tending to ignore some minor abnormal situation of the body and thus miss the optimal treatment time [ 1 – 3 ]. Women over the age of 45 are the usual and vulnerable victims of cervical cancer.…”